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Analysis of psycho-emotional state and the severity of asthenic syndrome in children with acute leukemia after the first stage of chemotherapy
Abstract
Introduction:
Children and adolescents with hematological diseases are constantly in a state of prolonged psychological stress caused by hospitalization, debilitating treatment, lifestyle changes, which ultimately leads to a significant reduction in the quality of life. In this connection it is necessary to study the dynamics of mental and emotional condition of the child at different stages of chemotherapy and the timing of formation of asthenic syndrome.
The aim:
Determine the presence of psycho-emotional disorders and the severity of asthenic syndrome in children with acute leukemia after the first stage of chemotherapy in order to further predict the development of this pathology and develop a package of solutions that minimize its manifestations.
Material and methods:
A survey of 36 children was conducted, of them 21 people aged 6–10 years old, 15 people aged 11–16 years old. There are 27 boys (75%) and 9 girls (25%). The survey was conducted on the 78th day of the ALL IC-BFM 2009 protocol, which corresponds to the end of the first phase of chemotherapy. In the survey did not participate children with the syndrome of multiple organ failure, as well as with the presence of background mental disorders. To assess the psycho-emotional state, a questionnaire was used: “state of health, activity, mood”, adapted for children. For the study of asthenia was used questionnaire I. K. Schatz.
Results:
The findings suggest that absolutely all children receiving chemotherapy at the end of the first phase have been violations of the psycho-emotional background. The index of state of health suffers the most, and to a lesser extent - activity. Indicators of state of health had lower values in the older group - from 11 to 16 years. Thus according to the data in the group of children aged 6 to 10 years being the average was 4.02 ± 0.09 (p <0.05), in children age 11 - 16 years - 3.83 ± 0.11 (p <0.05). The average activity substantially the same in groups and indicates a favorable condition. Mood indicators are also within the framework of a favorable state in both groups. Also during the investigation revealed that the general for all children is a symptom asthenic. According to the data, fatigue reaction (less than 7 points) was present only in 9 children (25%). The most numerous manifestations were moderate asthenia - 21 children (58%). Severe asthenia (13 - 18 points) was observed only in 6 children (17%).
Conclusions:
This study will allow to develop a package of solutions for the prevention and minimization of asthenic syndrome in children with acute leukemia receiving chemotherapy.
... Відомо, що у здорових людей тривалість сну 4 години на добу протягом тривалого часу призводить до зниження когнітивної продуктивності. А порушення гігієни сну при різних захворюваннях може призводити до погіршення відгуку на проводимо терапію та формування хронічного больового синдрому [5,6]. Та, нажаль, дуже часто проблему сну у пацієнтів в лікувальних закладах недооцінюють. ...
Insomnia is one of the most common clinical syndromes of somnological disorders, including any sleep disorders under sufficient time and appropriate sleeping conditions. Significant sleep disturbances are common in children who enter the intensive care unit. Between 18 and 65 per cent of children aged between 2 and 18 hospitalized in the intensive care unit have a clinical condition of acute confusion, better known as delirium. Sleep fragmentation, reduction of total sleep time, lack of slow, deep sleep and rapid sleep, and shift of sleep time are changes that can also act as insomnia triggers. Their presence worsens the course of the disease in the patient, prolongs the hospital stay, and increases the risk of complications and lethality. Circadian sleep disorder is a condition that requires close monitoring. Although insomnia therapy approaches are not yet reliable, early diagnosis of insomnia can reduce the duration of the delirium. Sleep assessment includes questionnaires and diaries. However, it was recognized that, despite the difficulties in implementing and interpreting polysomnography, it was still a gold standard for more accurate detection of changes in sleep phases and the difference between normal and abnormal sleep. In the absence of a polysomnograph, it is permissible to use a prolonged video assisted EEG. The inventive multimodal video-assisted monitoring method makes it possible to diagnose sleep disorders, pain syndrome and differential diagnosis of apnoea with cardiac and conductivity disorders or abnormal brain activity, including the presence of sub-clinical convulsions in patients of high-risk groups using a safe and non-invasive method for analyzing trends in the total bioelectric activity of different biological structures of a child. The validation of questionnaires according to the age of the child is also an important step in the timely diagnosis of sleep disorders in older children.
... Достовірно відомо, що передчасно народжені діти набагато чутливіші до болю, ніж доношені новонароджені, і у них формується тривала гіпералгезія внаслідок дії травмуючих факторів [2]. Нелікований біль призводить до зниження ефективності лікування основного захворювання, погіршення результатів виходжування, формуван-ня хронічного болю та астенічного синдрому у віддалені терміни часу [3]. ...
Vincristine (VNC) is commonly used to treat pediatric cancers, including the most prevalent childhood malignancy, acute lymphoblastic leukemia. Although clinical evidence suggests that VNC causes peripheral neuropathy in children, the degree to which pediatric chemotherapeutic regimens influence pain sensitivity throughout life remains unclear, in part because of the lack of an established animal model of chemotherapy-induced neuropathic pain during early life. Therefore, this study investigated the effects of VNC exposure between postnatal days (P) 11 and 21 on mechanical and thermal pain sensitivity in the developing rat. Low doses of VNC (15 or 30 μg/kg) failed to alter nociceptive withdrawal reflexes at any age examined compared with vehicle-injected littermate controls. Meanwhile, high dose VNC (60 μg/kg) evoked mechanical hypersensitivity in both sexes beginning at P26 that persisted until adulthood and included both static and dynamic mechanical allodynia. Hind paw withdrawal latencies to noxious heat and cold were unaffected by high doses of VNC, suggesting a selective effect of neonatal VNC on mechanical pain sensitivity. Gross and fine motor function appeared normal after VNC treatment, although a small decrease in weight gain was observed. The VNC regimen also produced a significant decrease in intraepidermal nerve fiber density in the hind paw skin by P33. Overall, the present results demonstrate that high-dose administration of VNC during the early postnatal period selectively evokes a mechanical hypersensitivity that is slow to emerge during adolescence, providing further evidence that aberrant sensory input during early life can have prolonged consequences for pain processing.
Background: Vincristine (VCR) induced peripheral neuropathy is a common complication in children
with acute lymphoblastic leukemia (ALL).
Procedures: A retrospective data analysis over an interval of 10 years (2006–2016) of all children
with ALL seen at Sultan Qaboos University Hospital was carried out. Electronic medical records of
eligible patients were reviewed. Patients with clinical evidence of neuropathy and abnormal nerve
conduction studies (NCSs) were included in the study.
Results: Nineteen (nine females and 10 males) out of 103 pediatric patients developed VCRrelated
neuropathy, and their age ranged between 2.5 and 14 years. Symptoms started after 2–
11 doses of VCR. All 19 patients had documented peripheral neuropathy on NCSs. The autonomic
nervous system and cranial nerves affection was relatively common in our patients; two presented
with bradycardia, two patients with unexplained tachycardia, and five had abdominal pain and constipation,
complicated by typhlitis in two patients. One patient developed unilateral hearing loss.
Two patients developed severe life-threatening cranial nerve involvement with bilateral ptosis
and recurrent laryngeal nerve involvement presented as vocal cord paralysis, hoarseness of voice,
frequent chocking, and aspiration episodes.
Conclusions: Peripheral neuropathy was the commonest form of VCR-related neuropathy. Autonomic
neuropathy was relatively common in our patients. Cranial neuropathy is a serious side
effect of VCR that can be severe, involving multiple cranial nerves and needs prompt recognition
and management. Concomitant administration of pyridoxine and pyridostigmine does not seem to
protect against further neurological damage in some patients.
KEYWORDS
autonomic, cranial, leukemia, neuropathy, vincristine
Background:
Health-related quality of life (HRQoL) from diagnosis until end of treatment for children with acute lymphoblastic leukaemia was investigated, examining effects of age, gender, risk-stratified treatment regimen, and therapy intensity (one vs. two 'delayed intensifications' [DIs]).
Method:
In a multi-centre prospective study, parents reported their child's generic and disease-specific HRQoL and their own care-giving burden at five time points. From 1,428 eligible patients, 874 parents completed questionnaires at least once during treatment.
Results:
At each time point, generic HRQoL was significantly lower than equivalent norm scores for healthy children. HRQoL decreased significantly at the start of treatment, before recovering gradually (but remained below pre-treatment levels). Parents reported that older children worried more about side effects and their appearance, but showed less procedural anxiety than younger children. Concern for appearance was greater among girls than boys. Compared to Regimen B (i.e. additional doxorubicin during induction and additional cyclophosphamide and cytarabine during consolidation chemotherapy), patients receiving Regimen A had fewer problems with pain and nausea. There were no statistically significant differences in HRQoL by number of DI blocks received.
Interpretation:
HRQoL is compromised at all stages of treatment, and is partly dependent on age. The findings increase understanding of the impact of therapy on children's HRQoL and parental care-giving burden, and will contribute to the design of future trials.
Vincristine, a critical component of combination chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL), can lead to vincristine-induced peripheral neuropathy (VIPN). Longitudinal VIPN assessments were obtained over 12 months from newly diagnosed children with ALL (N=128) aged 1-18 years who received vincristine at one of four academic children's hospitals. VIPN assessments were obtained using the Total Neuropathy Score-Pediatric Vincristine (TNS©-PV), National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE©), Balis© grading scale, and Pediatric Neuropathic Pain Scale©-Five (PNPS©-5). Of children who provided a full TNS©-PV score, 85/109 (78%) developed VIPN (TNS©-PV ≥4). Mean TNS©-PV, grading scale, and pain scores were low. CTCAE©-derived grades 3 and 4 sensory and motor VIPN occurred in 1.6%/0%, and 1.9%/0% of subjects, respectively. VIPN did not resolve in months 8-12 despite decreasing dose density. VIPN was worse in older children. Partition cluster analysis revealed 2-3 patient clusters; one cluster (n=14) experienced severe VIPN. In this population, VIPN occurs more commonly than previous research suggests, persists throughout the first year of treatment, and can be severe.
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The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established.
Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute).
The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001).
Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.
Background:
Vincristine (VCR) is one of the main drugs of acute lymphoblastic leukemia (ALL) treatment. Azole antifungal medications are used for treatment or prophylaxis of invasive fungal infections in acute leukemia. Coadministration of these drugs increases the risk of VCR toxicity.
Observations:
We presented a girl with ALL using posaconazole prophylaxis. She developed VCR toxicity that included tubulopathy, high blood pressure, neuropathic pain, difficulty walking, diffuse muscular weakness, constipation, abdominal pain.
Conclusions:
There are limited data in children with ALL for posaconazole prophylaxis. We recommend that VCR side effects should be evaluated by careful monitoring of the patients who are on this combination therapy.
Background:
Pegylated-asparaginase (PEG-ASP) is a critical treatment for pediatric acute lymphoblastic leukemia (ALL) and has traditionally been delivered via intramuscular (IM) injection. In an attempt to reduce pain and anxiety, PEG-ASP has increasingly been delivered via intravenous (IV) administration. The study objective was to perform a meta-analysis and systematic review to compare and generate pooled hypersensitivity rates for IM and IV PEG-ASP.
Methods:
A systematic literature search was conducted for all epidemiological studies that investigated IV and IM hypersensitivity rates for pediatric ALL. Included studies were critically appraised using the GRACE checklist. Pooled estimates and odds ratios with 95% confidence intervals (CIs) for IM and IV hypersensitivity rates were derived based on either a random or fixed effects model.
Results:
Four studies satisfied the inclusion criteria and were of adequate quality. The random effects pooled hypersensitivity rates were 23.5% (95% CI 14.7-33.7) and 8.7% (95% CI 5.4-12.8) for IV and IM, respectively. The fixed effects pooled odds ratio after adjusting for publication bias was 2.49 (95% CI 1.62-3.83), indicating a significantly higher risk of hypersensitivity for IV over IM PEG-ASP. This risk is far more pronounced for high-risk (HR) patients compared with standard-risk (SR) patients (IV vs. IM: HR ↑35.2% and SR ↓2.9%).
Conclusions:
Although administering PEG-ASP through IV is preferable for patients, it poses a significantly higher risk of hypersensitivity when compared with IM administration, especially for HR patients. We recommend pediatric oncologists consider treating patients with HR pediatric ALL with IM PEG-ASP to reduce the risk of hypersensitivity.
INTRODUCTION. Leukaemia is the most frequent type of cancer at the paediatric age. The cure rate is 80% with intensive chemotherapy, which improves survival but also often increases the frequency of adverse side effects, including those of a neurological nature. AIMS. To describe the frequency and characteristics of the neurological complications (NC) in patients with acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML), as well as to identify factors associated to their presence, neurological morbidity and survival rate. PATIENTS AND METHODS. A retrospective study was conducted of the NC present in patients with ALL and AML between 1997 and 2012 treated and followed up by the child onco-haematology unit. The following variables were analysed: demographic data, oncological diagnosis, treatment and NC. RESULTS. Altogether 157 patients were included, 145 without infiltration of the central nervous system at diagnosis and eight with infiltration (rate of NC of 14% and 12%, respectively). The most frequent NC were: neuropathies (31%), altered levels of consciousness (27%), convulsions (22%) and headache (12%). Forty per cent of the patients with NC presented sequelae but none of them died as a consequence of the NC. More NC were detected in the age group of children aged under 6 years with high-degree ALL, at higher levels of severity and in patients who had received a haematopoietic stem-cell transplant, all of them with statistically significant differences. CONCLUSIONS. Neurological complications are common in patients with acute leukaemia, especially in those at a high-risk stage (above all if they are under the age of 6 years) and with haematopoietic stem-cell transplant. The associated mortality rate is low.
Bolevoj sindrom u detej s gemoblastozami. Sovremennoe sostoyanie problemy
- N M Adamchuk
- O Y Sorokina